November 04, 2022

Maryland Congressional Delegation Urges State Action on Innovative Health Care Model

Total Cost of Care Model has allowed Maryland hospitals and providers to continue providing quality care while others around nation have cut back

U.S. Senators Chris Van Hollen and Ben Cardin and Congressmen Steny Hoyer, Dutch Ruppersberger, John Sarbanes, Kweisi Mfume, Andy Harris, M.D., Anthony Brown, Jamie Raskin and David Trone today wrote to Gov. Larry Hogan urging the state to work with stakeholders to protect Maryland’s unique, innovative and effective health care model. The Members of Congress underscored that the state is at risk of failing to meet its contractual obligations to the Centers for Medicare and Medicaid Services (CMS).

“We write to express our concern that the state is projected to fail three of the six targets of the Maryland Total Cost of Care (TCOC) Model in calendar year (CY) 2022,” the members wrote. “As you know, the model has been a crucial part of our state’s health care system, especially through the COVID-19 pandemic, providing much needed financial stability to health care providers while incentivizing addressing population health to drive better health outcomes for Marylanders. Though the Centers for Medicare & Medicaid Services (CMS) will not make an official determination the state has failed to meet the model requirements until summer 2023, we urge you to work closely with the Health Services Cost Review Commission (HSCRC), Maryland health care stakeholders, and the federal delegation to take decisive action to ensure the long-term sustainability of the Maryland TCOC Model.”

The full text of the letter is available here and below.

Dear Governor Hogan:

We write to express our concern that the state is projected to fail three of the six targets of the Maryland Total Cost of Care (TCOC) Model in calendar year (CY) 2022. As you know, the model has been a crucial part of our state’s health care system, especially through the COVID-19 pandemic, providing much needed financial stability to health care providers while incentivizing addressing population health to drive better health outcomes for Marylanders. Though the Centers for Medicare & Medicaid Services (CMS) will not make an official determination the state has failed to meet the model requirements until summer 2023, we urge you to work closely with the Health Services Cost Review Commission (HSCRC), Maryland health care stakeholders, and the federal delegation to take decisive action to ensure the long-term sustainability of the Maryland TCOC Model.

Since the early 1970s, Maryland has operated a unique health care delivery system, promoting access to care, equity, financial stability, and hospital accountability. In 2014, the State replaced the 36-year-old Medicare waiver with the Maryland All-Payer Model, entering into a contract with CMS. In 2018, Maryland and CMS entered into a new agreement to test the Maryland TCOC Model, which builds upon the Maryland All-Payer Model, and is the first CMS model to hold a state fully at risk for the total cost of care for Medicare beneficiaries. Now, the Maryland TCOC Model is in its fourth year of what has been a successful eight-year agreement.

In its contract with CMS, Maryland agreed to meet six TCOC Model targets. Though the causes are still being determined, for CY 2022, Maryland is projected to fail to meet three targets: (1) the annual Medicare TCOC savings; (2) the TCOC guardrail test; and (3) reducing Medicare readmission rates. Failure to meet these targets may result in the loss of Maryland’s ability to continue operating our unique health care delivery system, particularly as the state is preparing to enter negotiations for the next phase for the state once the TCOC Model contract ends in 2026.

Our state and nation have faced tremendous challenges as a result of the COVID-19 pandemic, and our health care system continues to deal with the impacts of this public health crisis. In the midst of these challenges, the entire state has benefited from the Maryland TCOC Model, which allows hospitals and providers to maintain high-quality health care services while hospitals around the nation cut back. Despite the critical role played by the TCOC Model, the state is at 1 risk of failing to meet its contractual obligations to CMS required under the TCOC Model. We urge you to collaborate with stakeholders across the state to ensure that Marylanders can continue to access high-quality, affordable, and equitable health care throughout the state.

Sincerely,